Data vs. Health Equity: SDoH Analytics Can Help Address the Healthcare Inequities Exposed by COVID-19

The pandemic emphasized disparities in quality of care across populations. Value-based care models can be an integral part of the solution. To support at-scale transition across the industry, Change Healthcare is introducing Prometheus Analytics® API. Built on a foundation of big data—the analysis of more than $1 trillion of claims from 100 million individuals—the new API is a cloud-based service that allows open collaboration, rapid deployment, and improved clinical outcomes through the development of standardized episodes of care, which form the foundation of any value-based care strategy. 

Delivering Positive Healthcare Outcomes Is Critical to Delivering Value

When people talk about value-based healthcare, they tend to focus on overall cost savings and system efficiency—that is, moving away from the system of misaligned payment incentives created by fee-for-service models. But the potential for addressing healthcare inequities is equally as important. Delivering positive outcomes, above and beyond the impact of cost, is critical to delivering value.

While there should no longer be any doubt about how different the healthcare experience can be based on factors like race, socioeconomic status, or community resources, our experience with COVID-19 once again laid these inequities bare. According to the Kaiser Family Foundation, multiple analyses of federal, state, and local data show that people of color suffered disproportionately from COVID-19 cases, hospitalizations, and deaths. We’ve also seen a gulf in vaccination rates between communities, revealing that communities of color have been disproportionately negatively affected. With more data than ever illuminating the impacts of social determinants on healthcare, we’re now beginning to understand the problem well enough to create solutions.

Value-based care models can help address these disparities by supporting providers who take steps to better understand and engage vulnerable and underserved members of the populations they support. Working from a standardized care delivery methodology or episode of care (EOC) to ensure consistent care delivery across an entire population, payers can work with their care providers and members to identify focus areas at a community, sub-population, or individual level that require additional support. Analyzing cost and quality alongside member-level data is difficult to do in a way that’s reproducible and scalable across multiple populations. It’s important not just to succeed once in a small-scale pilot program but to be able to replicate success nationwide so as many people as possible can benefit. 

The good news is that we have the means to make this a reality. Access to open, standard, and transparent clinical content and criteria allows everyone the opportunity to move past the analytics black box and collaborate to define and deliver value. Here at Change Healthcare, our Prometheus Analytics platform crunches a mind-boggling number of healthcare transactions— an estimated $1 trillion worth of claims a year from approximately 100 million healthcare consumers covered by commercial insurance and Medicaid. By turning this data into actionable information, we help health plans, technology providers, government agencies, and health systems craft and operate effective programs in a way that gives everyone a chance to receive high-value care.

The impacts of studying this data are significant. Our customers—healthcare providers, payers, and researchers—are developing EOCs for both primary care and chronic-condition management. Our customers see improved satisfaction and member engagement with patients involved in specific EOCs. With standardized EOCs, we can compare performance and healthcare services accurately—not just apples-to-apples, but red Fuji apples to red Fuji apples. Prometheus Analytics API gives payers a fair, realistic, and transparent blueprint for managing value-based payments across more than 90 standardized care episodes, with more on the way.

We are taking the next step in this journey with our new Prometheus Analytics API. As the API is a cloud-based service, licensed technology builders can easily access the core content, with low barriers to entry. This helps prioritize the real work: the fair and effective delivery of high-quality healthcare. The transparency of Prometheus Analytics enables licensed users to collaborate with their ecosystem of healthcare stakeholders—from consumers to providers, payers to government agencies—so we can all work together to deliver value. Because Prometheus Analytics API is cloud-based, it also enables faster, more consistent deployment of the technology, cutting timelines from 7–9 months to 1–2 months. At Change Healthcare, we believe technology access should not be a barrier to progress.   

The pandemic once again illustrated what we already knew—that for all the greatness of our healthcare system, there remain imbalances that must be addressed. The hope is that this experience might spur further action. At Change Healthcare, we are redoubling our efforts to make the American healthcare system work for everyone.